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A multilevel approach to botulinum toxin type A treatment of the (ilio)psoas in spasticity in cerebral palsy
Author(s) -
Molenaers Guy,
Eyssen Marijke,
Desloovere Kaat,
Jonkers Ilse,
Cock Paul De
Publication year - 1999
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.1999.tb00036.x
Subject(s) - spasticity , cerebral palsy , medicine , gait , botulinum toxin , gait analysis , physical medicine and rehabilitation , muscle contracture , contracture , hypertonia , iliopsoas muscle , electromyography , iliopsoas , hip flexion , range of motion , physical therapy , surgery , anesthesia , abscess
In spasticity, flexion deformity of the hip is frequently associated with contracture or hyper‐reflexia of the psoas muscle. Botulinum toxin type A (BTX‐A) has been used for some considerable time in the management of paediatric gait disorders. We have been using a multilevel approach to manage spasticity in cerebral palsy for several years, the combination of gait analysis and clinical evaluation being important for the selection of target muscles for BTX‐A injections. Twenty cerebral palsy children (12 female) with spasticity were treated with BTX‐A injections (BOTOX® mean dose, 2 U/kg body weight) into the psoas muscle. Patients were monitored using range of motion measurements of maximal hip extension, clinical estimates of hypertonia in the hip flexors, gait analysis (three‐dimensional kinematics and kinetics) and surface electromyography of major lower limb muscles. Full gait analysis was carried out on 12 of the patients. Significant clinical improvements were observed following 15 of the 21 psoas treatments. Furthermore, the kinematics results of gait analysis showed improvement in one or more parameters in nine of the 12 patients. In conclusion, we have demonstrated the value of a multilevel approach to BTX‐A treatment in the management of spasticity in children with cerebral palsy.